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Childhood forecasting of a small segment of the population with large economic burden

Nature Human Behaviour volume 1, Article number: 0005 (2016) | Download Citation


Policymakers are interested in early-years interventions to ameliorate childhood risks. They hope for improved adult outcomes in the long run that bring a return on investment. The size of the return that can be expected partly depends on how strongly childhood risks forecast adult outcomes, but there is disagreement about whether childhood determines adulthood. We integrated multiple nationwide administrative databases and electronic medical records with the four-decade-long Dunedin birth cohort study to test child-to-adult prediction in a different way, using a population-segmentation approach. A segment comprising 22% of the cohort accounted for 36% of the cohort’s injury insurance claims; 40% of excess obese kilograms; 54% of cigarettes smoked; 57% of hospital nights; 66% of welfare benefits; 77% of fatherless child-rearing; 78% of prescription fills; and 81% of criminal convictions. Childhood risks, including poor brain health at three years of age, predicted this segment with large effect sizes. Early-years interventions that are effective for this population segment could yield very large returns on investment.

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We thank Dunedin Study members, their families and Dunedin Study founder Phil Silva. This research received support from US National Institute on Aging (NIA) grants AG032282, AG048895, AG049789, UK Medical Research Council (MRC) grant MR/K00381X and ESRC grant ES/M010309/1. The Dunedin Study was supported by the New Zealand Health Research Council and New Zealand Ministry of Business, Innovation and Employment (MBIE). Additional support was provided by the Jacobs Foundation and the Avielle Foundation. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. We thank D. Reiss, J. Heckman and his seminar members, and the New Zealand agencies that offered guidance and assistance to the Dunedin Study. We also thank Z. van der Merwe (ACC), C. Lewis (Ministry of Health), M. Wilson and R. Ota (Ministry of Social Development), the Otago Police District Commander, P. Stevenson, J. Curren and the Dunedin Police. The Otago University Ethics Committee, Duke University and King’s College London provided ethical approval for the Dunedin Study. Participants gave written consent before data were collected.

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  1. Department of Psychology & Neuroscience, Duke University, Durham, North Carolina 27708, USA

    • Avshalom Caspi
    • , Renate M. Houts
    • , Honalee Harrington
    •  & Terrie E. Moffitt
  2. Department of Psychiatry & Behavioural Sciences, Duke University School of Medicine, Durham, North Carolina 27708, USA

    • Avshalom Caspi
    •  & Terrie E. Moffitt
  3. Center for Genomic and Computational Biology, Duke University, Durham, North Carolina 27708, USA

    • Avshalom Caspi
    •  & Terrie E. Moffitt
  4. Social, Genetic, & Developmental Psychiatry Research Centre, Institute of Psychiatry, Psychology, & Neuroscience, King’s College London, London SE5 8AF, UK

    • Avshalom Caspi
    •  & Terrie E. Moffitt
  5. Department of Medicine, Duke University School of Medicine, Durham, North Carolina 27708, USA

    • Daniel W. Belsky
  6. Social Science Research Institute, Duke University, Durham, North Carolina 27708, USA

    • Daniel W. Belsky
  7. Department of Psychology, University of Otago, Dunedin 9016, New Zealand

    • Sean Hogan
    • , Sandhya Ramrakha
    •  & Richie Poulton


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A.C., R.P. and T.E.M. designed the research, and A.C., R.M.H. and T.E.M. wrote the manuscript. A.C., S.H., S.R., R.P. and T.E.M. collected the data, and it was analysed by A.C., R.M.H. and H.H. All authors reviewed drafts, provided critical feedback and approved the final manuscript.

Competing interests

The authors declare no competing interests.

Corresponding author

Correspondence to Avshalom Caspi.

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